Patient's Special Arrangement With Physician Leads to Lawsuit After Death

This case involves a patient who was adamant that he wanted only a limited standard of care
This case involves a patient who was adamant that he wanted only a limited standard of care

As every clinician knows, working with patients can sometimes be challenging. There are always going to be some patients who have unusual requests, who want certain medications or tests, or who refuse certain screenings. While you can't necessarily change your patient's behavior, you can at least protect yourself by taking very clear notes.

The physician in this month's case was a general practitioner who had a suite of offices in a medical building. Dr. N was 52, and had learned over her 20 plus years in practice that patients differ greatly in what they want and expect from a physician. She could think of no better example of this than Mr. C. The physician had been treating Mr. C, if one could call it ‘treating,' for about five years. She remembered the first time he had come into the office.

“I'm not looking for a primary care physician,” the patient said, “I'm aware that my blood pressure is borderline high. I want to have it monitored by you. I will come in twice a year. I will pay out of pocket – no insurance. But I'm not interested in anything more than that.”

Surprised, Dr. N tried at first to reason with the patient. “Do you have a primary care physician?” she asked. “Because you really should. Why don't we just do a basic physical?”

But the patient was adamant. “No,” he said. “I don't want a basic physical or anything else. Just please monitor my blood pressure.”

“You know you can do that at the pharmacy,” said Dr. N, “or buy a home blood pressure monitor.”

“I know,” said Mr. C. “I would like you to do it.”

Dr. N agreed and started a patient file for Mr. C where she noted his blood pressure reading every six months. He showed up regularly for five years but then missed an appointment.

When Dr. N's office staff called him, they were told that he had been hospitalized after several days of severe stomach pain and no bowel movements.